The figure was based primarily on a county survey completed in 2006 of
more than 5,200 women ages 13 to 56 who had recently delivered. The
percentage of unplanned pregnancies was about the same among women who
gave birth and those who suffered stillbirths and miscarriages,
according to Dr. Susie Baldwin, chief of the department’s health
assessment unit, which produced the study “Healthy Women, Healthy
Children.”

The study did not include women whose latest pregnancy ended in
abortion, who earlier studies show have a much higher percentage of
unplanned pregnancies, Baldwin said.

Although state
studies show that for the same time period as the county study about 43% of
births were unplanned statewide, the county numbers still trouble
public health experts because women who do not realize they are pregnant
are likely to delay prenatal care and may smoke or drink alcohol. Women
who have had another child within six months of an unplanned pregnancy
are at even greater risk, and are more likely to have a child born prematurely
with a low birth weight, researchers found.

“All pregnancies should be planned. An unplanned pregnancy should be a
rare thing,” Baldwin said. “It goes back to education and access.”

A lack of health insurance and regular access to care may have
contributed to the number of unplanned pregnancies, Baldwin said.

Researchers found 23% of women of childbearing age lacked health
insurance, and 20% said they did not have a regular source of health
care. Those percentages were even higher among women who had recently
delivered babies — 36% lacked insurance, 33% lacked regular health care.

The lack of regular care may affect women’s ability to plan for
pregnancy.

About 80% of those at risk for pregnancy reported using a regular form
of birth control the last time they had sex, although that percentage
varied by ethnicity — 87% of whites compared with 81% of Asians, 80% of
Latinas and 67% of African Americans.

About 82% of women who had recently delivered a baby said they had
received information about the importance of prenatal vitamins
containing folic acid, but only 57% of them had taken the vitamins
before becoming pregnant.

Researchers proposed developing minimum preconception care requirements
and extending Medi-Cal benefits for mothers with high-risk pregnancies
for two years postpartum.

“The opportunity to impact the health of a baby starts before
conception, and the health of a potential mother should be a priority
long before pregnancy,” said Jonathan E. Fielding, the county’s public
health director.

Worldwide, the rate of unintended pregnancy declined by 20% between 1995
and 2008, from 69 to 55 per 1,000 women aged 15 to 44. The decline was
greater in the more developed world, where the rate fell by 29% (from 59
to 42 per 1,000 women), than in the less developed world, where it fell
by 20% (from 71 to 57 per 1,000), according to a study by the
Guttmacher Institute.